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R upper ureteric calculus- OT- cyst+ Dj stenting
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Reading File
Here is the transcribed and interpreted OT note for the Right Upper Ureteric Calculus - Cystoscopy + DJ Stenting procedure:
OT Note - Transcription & Interpretation
| Field | Handwritten | Interpretation |
|---|---|---|
| Anaesthesia type | LA | Local Anaesthesia (likely spinal/LA for endoscopy) |
| Nurse | Gole / Gr | Scrub nurse name |
| Position | Lithotomy | Lithotomy position |
| Incision | PR / PU | Per Urethra (transurethral approach) |
| Procedure | (see below) | Step-by-step below |
Procedure Steps (Typed Out)
Procedure: Cystoscopy + Right URS attempted + DJ Stenting
- Cystoscopy done - rigid cystoscope introduced per urethra
- Rt UVJ cannulated - Right ureterovesical junction identified and cannulated
- Guidewire passed - safety guidewire advanced up the right ureter
- URS dilated - ureteral orifice/distal ureter dilated to allow ureteroscope passage
- URS passed - ureteroscope advanced into the right ureter
- Ureter tight - ureter found to be tight/narrow (couldn't negotiate further - likely couldn't reach the upper ureteric stone)
- 5 Fr DJ stent kept - 5 French Double-J (ureteric) stent placed to passively dilate the ureter and relieve obstruction
- Foley's kept - Foley urethral catheter placed at end of procedure
Clinical Interpretation
Since the ureter was tight and the scope could not be negotiated up to the upper ureteric calculus, a DJ stent was placed as a first-stage procedure. This is standard practice when:
- The ureter is too narrow to allow ureteroscope passage safely
- Risk of ureteral injury is high if forced
- The stent passively dilates the ureter over 2-4 weeks
- A second-stage URS + lithotripsy is then planned after the ureter has dilated sufficiently
The 5 Fr DJ stent will also provide drainage relief if there is any hydronephrosis from the obstructing upper ureteric stone.
Suggested Typed OT Note
Procedure: Cystoscopy + Right DJ StentingUnder LA (spinal), patient placed in lithotomy position. Rigid cystoscope introduced per urethra. Cystoscopy done. Right UVJ identified and cannulated. Guidewire passed into right ureter. Ureteroscope introduced - ureter found to be tight. URS could not be negotiated to the level of the calculus. Decision taken to DJ stent and plan second-stage URS. 5 Fr DJ stent placed in situ under fluoroscopic guidance. Foley's catheter placed. Procedure concluded uneventfully.
Plan: Re-schedule for definitive URS + Holmium laser lithotripsy / pneumatic lithotripsy after 3-4 weeks of stent-induced ureteral dilation.
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